夜间家庭血压监测的最佳方案：与动态血压的一致性及其与器官损害的关系。

The optimal night-time home blood pressure monitoring schedule: agreement with ambulatory blood pressure and association with organ damage.

机构信息

Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital.

Hypertension and Cardiovascular Disease Prevention Center, Fourth Department of Medicine, Evangelismos Hospital, Athens, Greece.

出版信息

J Hypertens. 2018 Feb;36(2):243-249. doi: 10.1097/HJH.0000000000001562.

DOI:10.1097/HJH.0000000000001562

PMID:28915229

Abstract

OBJECTIVE

Night-time home blood pressure (HBP) monitoring has emerged as a feasible, reliable and low-cost alternative to ambulatory blood pressure (ABP) monitoring. This study evaluated the optimal schedule of night-time HBP monitoring in terms of agreement with night-time ABP and association with preclinical target-organ damage.

METHODS

Untreated hypertensive adults were evaluated with ABP (24-h) and HBP monitoring (daytime: six days, duplicate morning and evening measurements; night-time: three nights, three-hourly automated measurements/night), and determination of left ventricular mass index, common carotid intima-media thickness and urinary albumin excretion.

RESULTS

A total of 94 patients with all nine night-time HBP measurements were analysed [mean age 51.8 ± 11.1 (SD) years, men 57%). By averaging an increasing number of night-time systolic HBP readings, there was a consistent trend towards stronger association of night-time HBP with night-time ABP (correlation coefficients r increased from 0.69 to 0.81), and with target-organ damage indices (for left ventricular mass index r increased from 0.13 to 0.22, carotid intima-media thickness 0.12-0.25, urinary albumin excretion 0.33-0.41). However, no further improvement in the association was observed by averaging more than four to six night-time readings. The diagnostic agreement between HBP and ABP in detecting nondippers was improved by averaging more readings, with a plateau at four readings (single reading: agreement 81%, kappa 0.37; four readings: 88%, 0.49; nine readings: 84%, 0.40).

CONCLUSION

A two-night HBP schedule (six readings) appears to be the minimum requirement for a reliable assessment of night-time HBP, which gives reasonable agreement with ABP and association with preclinical organ damage.

摘要

目的

夜间家庭血压（HBP）监测已成为一种可行、可靠且低成本的替代动态血压（ABP）监测的方法。本研究评估了夜间 HBP 监测的最佳方案，即与夜间 ABP 的一致性和与临床前靶器官损伤的相关性。

方法

对未经治疗的高血压成年人进行 ABP（24 小时）和 HBP 监测（白天：六天，早晚各测两次；夜间：三晚，每三小时自动测量/晚），并测定左心室质量指数、颈总动脉内膜-中层厚度和尿白蛋白排泄率。

结果

共分析了 94 例所有 9 次夜间 HBP 测量值的患者[平均年龄 51.8±11.1（SD）岁，男性 57%]。通过平均增加夜间收缩压 HBP 读数的数量，夜间 HBP 与夜间 ABP 的相关性呈一致的增强趋势（相关系数 r 从 0.69 增加到 0.81），与靶器官损伤指标的相关性也呈增强趋势（左心室质量指数 r 从 0.13 增加到 0.22，颈动脉内膜-中层厚度 0.12-0.25，尿白蛋白排泄率 0.33-0.41）。然而，平均超过四到六次夜间读数后，相关性并未进一步改善。通过平均更多读数，夜间 HBP 和 ABP 在检测非杓型血压方面的诊断一致性得到改善，在平均四次读数时达到平台（单次读数：一致性 81%，kappa 值 0.37；四次读数：88%，0.49；九次读数：84%，0.40）。